Open AccessPrescription and Administration of Opioids to Hospital In‐patients, and Barriers to Effective Use
Author(s) -
Murnion Bridin P.,
Gnjidic Danijela,
Hilmer Sarah N.
Publication year - 2010
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/j.1526-4637.2009.00747.x
Subject(s) - medicine , opioid , medical prescription , oxycodone , referral , limiting , anesthesia , tertiary referral hospital , emergency medicine , family medicine , nursing , retrospective cohort study , mechanical engineering , receptor , engineering
Objective. This study aimed to describe prescribing and administration of opioids in a tertiary referral teaching hospital. Secondary aims were assessment of staff knowledge of opioid pharmacology and available preparations, and of perceived barriers limiting opioid use. Design. A cross‐sectional survey of in‐patients requiring opioid analgesia was performed. An anonymous semi‐structured questionnaire was administered to medical and nursing staff. Setting. Australian tertiary referral teaching hospital. Patients. All patients prescribed opioids on study wards over 3 months (N = 190). Results. Oxycodone was the most frequently prescribed opioid (51.4%). The majority (64.7%) of participants had incomplete pain relief, which was significantly associated with having opioid related side effects. There was no association between pain relief and prescribed daily dose or received daily dose of opioids. Limited understanding of opioid preparations, tolerance, and dependence was demonstrated by staff. The most common perceived barriers to opioid use included difficulties in identifying the right dose, staff time required to prescribe and monitor, and large numbers of preparations. While prescription of inadequate doses was perceived as a barrier, this study identified that submaximal doses were administered. An opioid educational session improved knowledge of opioid formulations. Conclusion. The majority of participants had incomplete pain relief and the maximum prescribed doses of opioids were not administered. Reported barriers included staff knowledge of opioid dose titration and opioid preparations, and time constraints. Identified barriers included poor knowledge of opioid preparations.